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Copyright ©ERS Journals Ltd 2006
Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment
1 Firestone Institute for Respiratory Health, St. Joseph's Healthcare and McMaster University, Hamilton, ON, and 3 Centre de recherche, Hôpital Laval, Institut universitaire de cardiologie et de pneumologie de l'Université Laval, QC, Canada, 2 NUPAIVA (Nucleo da Pesquisa em Asma e Inflamação das Vias Aéreas) – Universidade Federal de Santa Catarina, Florianopólis, Brazil.
CORRESPONDENCE: E. Pizzichini, NUPAIVA, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina 88040390, Brazil. Fax: 55 482347711. E-mail: pizzichi{at}matrix.com.br
Keywords: Airway inflammation, chronic obstructive pulmonary disease, eosinophils, induced sputum, inhaled corticosteroids
Received: June 20, 2005
Accepted January 2, 2006
The role of inhaled corticosteroids in the management of chronic obstructive pulmonary disease (COPD) remains controversial. The purpose of this study was to evaluate whether sputum eosinophilia (defined as eosinophils
Forty consecutive patients with effort dyspnoea (mean age 67 yrs; 52 pack-yr smoking history; post-bronchodilator forced expiratory volume in one second (FEV1) <60% predicted, consistent with moderate-to-severe smoking-related chronic airflow limitation) were enrolled. Subjects were treated with inhaled placebo followed by inhaled budesonide (Pulmicort Turbuhaler® 1,600 µg·day–1), each given for 4 weeks. While the treatment was single-blind (subject level), sputum cell counts before and after treatment interventions were double-blind, thus removing bias. Outcome variables included spirometry, quality-of-life assessment and 6-min walk test.
Sputum eosinophilia was present in 38% of subjects. In these, budesonide treatment normalised the eosinophil counts and, in comparison to placebo treatment, resulted in clinically significant improvement in the dyspnoea domain of the disease-specific chronic respiratory questionnaire (0.8 versus 0.3) and a small but statistically significant improvement in post-bronchodilator spirometry (FEV1 100 mL versus 0 mL; p<0.05).
In conclusion, sputum eosinophilia predicts short-term clinical benefit from high-dose inhaled corticosteroid treatment in patients with stable moderate-to-severe chronic obstructive pulmonary disease.
3%) predicts clinical benefit from inhaled corticosteroid treatment in patients with smoking-related clinically stable moderate-to-severe COPD.
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